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Drexel S, Watkins J, Tseng D. Robotic thoracoabdominal hernia repair: a novel approach. Hernia 2024; 28:249-254. [PMID: 37823978 DOI: 10.1007/s10029-023-02903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Thoracoabdominal hernias remain a rare and poorly understood entity. Data remain sparse as terminology varies in the literature and case reports demonstrate wide variability in technique. We present a novel approach for repair of thoracoabdominal hernias using the robotic platform. METHODS Two patients underwent a robotic thoracoabdominal hernia repair in June 2022. They were followed for 1 year with CT scans every 6 months to exclude recurrence. Patient demographics and peri-operative details including defect size, closure technique, mesh size, length of stay, and complications were reported. RESULTS Both patients successfully underwent a robotic repair of a thoracoabdominal hernia, addressing the intercostal hernia, diaphragmatic disruption, and flank hernia discretely during the operation. One patient had an uneventful recovery and discharged on post-operative day 3; the other developed a small bowel obstruction due to an early port site hernia which required surgical intervention. He eventually discharged on post-operative day 9. At one year, there is no clinical or radiographic evidence of recurrence for either patient. CONCLUSION Robotic thoracoabdominal hernia repair is feasible and offers a minimally invasive repair option for these extremely complex hernias.
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Affiliation(s)
- Sabrina Drexel
- Northwest Minimally Invasive Surgery, 1040 NW 22Nd Ave, Suite 470, Portland, OR, USA.
| | - Jeffrey Watkins
- Northwest Minimally Invasive Surgery, 1040 NW 22Nd Ave, Suite 470, Portland, OR, USA
| | - Daniel Tseng
- Northwest Minimally Invasive Surgery, 1040 NW 22Nd Ave, Suite 470, Portland, OR, USA
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2
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Moneim J. Abdominal intercostal hernia and costal arch repair. BMJ Case Rep 2021; 14:e247189. [PMID: 34848432 PMCID: PMC8634248 DOI: 10.1136/bcr-2021-247189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old asthmatic man presented with a history of chronic intermittent left-sided chest pains and a bulge-like deformity of his chest which became more prominent with expiration. He sustained a traumatic fall 2 years prior whereby he fractured his right humerus at the surgical neck, requiring total arthroplasty. Examination and CT imaging of the thorax revealed a left costal arch fracture with hemidiaphragm rupture and associated transperitoneal fat herniation. He underwent left thoracolaparotomy with costal arch and diaphragmatic hernia repair. He was discharged 48 hours postoperatively and is satisfied with good outcomes under initial follow-up. This case report highlights the surgical management of a condition that usually presents late after significant trauma and may progress to visceral strangulation if untreated.
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Affiliation(s)
- Jacob Moneim
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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3
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Morrell DJ, DeLong CG, Horne CM, Pauli EM. Radiographic identification of thoracoabdominal hernias. Hernia 2021; 26:287-295. [PMID: 34125302 DOI: 10.1007/s10029-021-02437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Hernias spanning both chest and abdominal walls are uncommon and associated with chest wall trauma, coughing and obesity. This study describes the radiographic appearance of these hernias to guide proper identification and operative planning. Proposed standardized reporting patterns are also presented. METHODS The cross sectional imaging of patients presenting with thoracoabdominal hernias was reviewed. Radiographic reports were supplemented by surgeon imaging review and operative findings during repair. Defect dimensions, hernia content, level of herniation, presence of osseous or cartilaginous disruption of the chest wall and degree of rib displacement were collected. Disruption of myofascial planes was also noted. RESULTS Six patients were identified. All hernias occurred below the 9th rib and were associated with complete intercostal muscle disruption. The transversus abdominis was disrupted in all hernias and the internal oblique was disrupted in five of the hernias. The majority (83%) had caudal rib displacement (median 6.8 cm compared to contralateral side). Median hernia width was 10.35 cm (1.6-19.1 cm) and median length was 10.2 cm (1.8-14.3 cm). Five patients had associated bone/cartilage injuries: two with 11th rib fractures, two with combined bone and cartilaginous fractures and one with a surgical rib resection. CONCLUSION The typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib.
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Affiliation(s)
- David J Morrell
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Colin G DeLong
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Charlotte M Horne
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA.
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4
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Blanco Terés L, García Sanz Í, Marín Campos C, Gancedo Quintana Á, Martín-Pérez E. Bowel obstruction secondary to transdiaphragmatic intercostal hernia. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:557-558. [PMID: 33872618 DOI: 10.1016/j.gastrohep.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Lara Blanco Terés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España.
| | - Íñigo García Sanz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
| | - Cristina Marín Campos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
| | - Álvaro Gancedo Quintana
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
| | - Elena Martín-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
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5
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Nho WY, Kim JO, Nam SY, Kee SK. Laparoscopic repair of transdiaphragmatic intercostal hernia following blunt trauma. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211005211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transdiaphragmatic intercostal hernia (TIH) is a rare clinical entity that generally occurs following trauma or surgical intervention, but it may occur spontaneously Case Report An 82-year-old Korean man presented with left-sided chest pain after falling off an agricultural vehicle. Physical examination revealed a bruised painful swelling in the left lower chest wall confirmed as hernia of the transverse colon and omentum through a defect in the diaphragm into the 7th intercostal space. Laparoscopic repair with a prosthetic mesh was successful with no sign of hernia recurrence 3 years after injury. Discussion TIH is uncommon. Depending on the associated injuries they may be repaired via the chest or abdomen and with the widespread advent of minimally invasive surgery this can be achieved laparoscopically or thoracoscopically. Small defects can be closed directly, but larger defects will require mesh coverage. Care should be taken to avoid using fixation tacks close to the central tendon and are best suited to peripheral defect repairs.
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Affiliation(s)
- Woo Young Nho
- Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Jae Oh Kim
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Soon Young Nam
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Se Kook Kee
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
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Ioannidis O, Mariorakis C, Malliora A, Christidis P, Loutzidou L, Mantzoros I, Pramateftakis MG, Kotidis E, Ouzounidis N, Foutsitzis V, Aggelopoulos S. Transdiaphragmatic Intercostal Hernia-An Unusual Hepatic Injury After a Car Accident: A Case Report and Review of the Literature. Discoveries (Craiova) 2021; 9:e123. [PMID: 34084890 PMCID: PMC8163488 DOI: 10.15190/d.2021.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Abstract
Transdiaphragmatic intercostal hernia, in which the abdominal contents of the hernia protrude through the diaphragm and the thoracic wall defect. is a very rare type of hernia with only a few cases having been reported in the literature. That type of hernia is usually manifested in male patients after trauma, penetrating or blunt. It is frequently presented with a palpable thoracic mass and pain. The indicated treatment is surgery. We present the case of a 60-year-old female admitted to the hospital after a car accident and suffered multiple rib fractures (6th, 7th, 8th right ribs / 7th, 8th, 9th left ribs), as well as flail thorax, hemothorax bilaterally, left subcutaneous emphysema and swelling of soft tissues of the right lateral thoracoabdominal wall. CT scan revealed herniation of hepatic parenchyma and intestinal loops into the thorax. The patient was treated surgically, and his postoperative course was uneventful. We also review the relevant literature concerning this transdiaphragmatic, intercostal hernia and identify 42 cases. Transdiaphragmatic intercostal hernia is a rare condition, usually manifested in male patients after trauma, penetrating or blunt. It is frequently presented with a palpable thoracic mass and pain. The indicated treatment is surgery.
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Affiliation(s)
- Orestis Ioannidis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Chrysovalantis Mariorakis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Anastasia Malliora
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Christidis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Lydia Loutzidou
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Ioannis Mantzoros
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Manousos George Pramateftakis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Efstathios Kotidis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Ouzounidis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasilis Foutsitzis
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4th Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Meader AG, Ciraulo DL, Rappold JF, Sawhney JS. Transdiaphragmatic Chest Wall Herniation. Am Surg 2020; 87:1129-1132. [PMID: 33338391 DOI: 10.1177/0003134820923297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The combination of traumatic simultaneous diaphragmatic rupture and chest wall herniation remains rare, with 42 cases of traumatic transdiaphragmatic intercostal hernia (TDIH) reported in the literature since 1946. An accurate count of cases is difficult to obtain, as TDIH nomenclature has been variable.1-5 Risk factors for traumatic TDIH are not well established. As these injuries are uncommon, best management techniques have yet to be established. Reported repair techniques include primary closure, closure with mesh, and implantation of prosthetic or autologous material. We present our single-center series of 7 patients, the largest reported to our knowledge, and discuss the challenges of repairing these difficult injuries. METHODS After obtaining institutional review board approval, data were abstracted from the electronic medical record on all adults who underwent evaluation and treatment for traumatic TDIH between July 2014 and January 2019. RESULTS Of the 7 cases of traumatic TDIH, 6 patients developed TDIH secondary to cough; the seventh patient presented with chronic chest wall pain after an episode of heavy lifting. All patients were obese or overweight. Pain and a "popping sensation" were the most common presenting symptoms. All patients underwent operative intervention with primary repair of the diaphragm and suture approximation of the ribs. 3 patients had onlay mesh repair of the chest wall and/or abdominal wall. 1 patient had plating of his rib fracture. 3 patients had a recurrence of the intercostal portion of the hernia No patients have undergone reoperation thus far. DISCUSSION While previously thought to more commonly occur on the left side due to the protective effects of the diaphragm,2 the majority in this series had right-sided injuries. Herniation through the ninth-10th interspace remains the most common location.4 Computed tomography imaging should be used for diagnosis and operative planning. It is best to manage these hernias acutely to re-establish normal anatomy. Mesh may be required in delayed reconstructions of if the chest wall cannot be re-approximated. Rib plating should be considered in cases of instability or flail. High rates of complications are not unexpected given the complicated and rare nature of the injury. Given the high rate of intercostal hernia recurrence, it is likely that mesh repair or should be more often used in the treatment of this injury.
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Affiliation(s)
- Anna G Meader
- 92602 Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - David L Ciraulo
- 92602 Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Joseph F Rappold
- 92602 Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Jaswin S Sawhney
- 92602 Department of Surgery, Maine Medical Center, Portland, ME, USA
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8
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Sapp A, Nowack T, Benjamin Christie D. Transdiaphragmatic Intercostal Hernia After Trauma: A Case Report, Literature Review, and Discussion of a Challenging Clinical Scenario. Am Surg 2020; 88:1364-1366. [PMID: 33118371 DOI: 10.1177/0003134820945273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander Sapp
- 5223 Mercer University School of Medicine, The Medical Center, Navicent Health, Macon, GA, USA
| | - Timothy Nowack
- 5223 Mercer University School of Medicine, The Medical Center, Navicent Health, Macon, GA, USA
| | - D Benjamin Christie
- 5223 Mercer University School of Medicine, The Medical Center, Navicent Health, Macon, GA, USA
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9
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Gooseman MR, Rawashdeh M, Mattam K, Rao JN, Vaughan PR, Edwards JG. Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries. Eur J Cardiothorac Surg 2020; 56:150-158. [PMID: 30770701 DOI: 10.1093/ejcts/ezz020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/10/2018] [Accepted: 12/22/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Taxonomy of injuries involving the costal margin is poorly described and surgical management varies. These injuries, though commonly caused by trauma, may also occur spontaneously, in association with coughing or sneezing, and can be severe. Our goal was to describe our experience using sequential segmental analysis of computed tomographic (CT) scans to perform accurate assessment of injuries around the costal margin. We propose a unifying classification for transdiaphragmatic intercostal hernia and other injuries involving the costal margin. We identify the essential components and favoured techniques of surgical repair. METHODS Patients presenting with injuries to the diaphragm or to the costal margin or with chest wall herniation were included in the study. We performed sequential segmental analysis of CT scans, assessing individual injury patterns to the costal margin, diaphragm and intercostal muscles, to create 7 distinct logical categories of injuries. Management was tailored to each category, adapted to the individual case when required. Patients with simple traumatic diaphragmatic rupture were considered separately, to allow an estimation of the relative incidence of injuries to the costal margin compared to those of the diaphragm alone. RESULTS We identified 38 patients. Of these, 19 had injuries involving the costal margin and/or intercostal muscles (group 1). Sixteen patients in group 1 underwent surgery, 2 of whom had undergone prior surgery, with 4 requiring a novel double-layer mesh technique. Nineteen patients (group 2) with diaphragmatic rupture alone had a standard repair. CONCLUSIONS Sequential analysis of CT scans of the costal margin, diaphragm and intercostal muscles defines accurately the categories of injury. We propose a 'Sheffield classification' in order to guide the clinical team to the most appropriate surgical repair. A variety of surgical techniques may be required, including a single- or double-layer mesh reinforcement and plate and screw fixation.
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Affiliation(s)
- Michael R Gooseman
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Majd Rawashdeh
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Kavitha Mattam
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Jagan N Rao
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Paul R Vaughan
- Department of Cardiothoracic Surgery, St Georges Hospital, London, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
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Smith-Singares E. Thoracolaparoscopic management of a traumatic subacute transdiaphragmatic intercostal hernia. Second case reported. Trauma Case Rep 2020; 28:100314. [PMID: 32509954 PMCID: PMC7264079 DOI: 10.1016/j.tcr.2020.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2020] [Indexed: 11/05/2022] Open
Abstract
Background Transdiaphragmatic intercostal hernias are extremely rare. Their physiopathology is different from traumatic diaphragmatic ruptures, and their clinical presentation and management strategies place them in a different category than abdominal intercostal hernias. Case presentation A 56 yo female presented to the outpatient trauma clinic with a symptomatic, subacute left sided transdiaphragmatic intercostal hernia secondary to a motor vehicle crash almost 3 months prior to presentation. The injury was managed with a combined thoracoscopic and laparoscopic approach, only the second time ever this has been reported. She was discharged on POD#3, and after 6 months of follow up continues to do well, without clinical evidence of hernia recurrence. Conclusion Minimally invasive management of this rare pathology is possible and should be encouraged.
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Affiliation(s)
- Eduardo Smith-Singares
- Washington University School of Medicine in St Louis, Memorial Hospital of Carbondale - The Barnes Jewish Collaborative, United States of America
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11
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Sagar AES, Faiz SA, Shannon VR. Cough-induced Transdiaphragmatic and Intercostal Herniation of the Liver. Am J Respir Crit Care Med 2019; 200:e145-e146. [PMID: 31251656 PMCID: PMC6884036 DOI: 10.1164/rccm.201810-1862im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ala-Eddin S Sagar
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Kelley JK, Biesterveld BE, White PT, Vercruysee GA. Post-traumatic intercostal and diaphragm hernias following a sneezing episode. BMJ Case Rep 2019; 12:12/5/e229250. [PMID: 31079046 DOI: 10.1136/bcr-2019-229250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trauma and sneeze-induced or cough-induced intercostal and diaphragm hernias are both rare phenomena, especially in combination. Management of these hernias is not well described, and there is no good evidence to guide operative management. Here we describe a rare presentation of coexisting intercostal and diaphragm hernias and surgical management with primary repair via a thoracotomy.
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Affiliation(s)
- Jesse K Kelley
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Ben E Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter T White
- Department of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary A Vercruysee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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13
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Kuckelman J, Karmy-Jones R, Windell E, Izenberg S, David JS, Long W, Martin MJ. Traumatic thoracic rib cage hernias: Operative management and proposal for a new anatomic-based grading system. Am J Surg 2018; 215:794-800. [PMID: 29336816 DOI: 10.1016/j.amjsurg.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management. METHODS Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location. RESULTS Twenty-four patients (20 blunt, 4 penetrating) underwent operative repair. Lung was the herniated organ in 88% with a median of 4 rib fractures and average size of 60.25 cm. Types of operation were well clustered by assigned TRCH grade. The majority required mesh (75%) and/or rib plating (79%). Complex tissue flap reconstruction was required in 10%. Full range-of-motion was maintained in 88% with79% returning to pre-injury activity levels. Five patients had continued pain at final follow up (mean = 7months). CONCLUSION The size and degree of injury has important implications in the optimal surgical management of TRCHs. These operative grades effectively direct surgical care for these rare and complex injuries.
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Affiliation(s)
- John Kuckelman
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, United States
| | - Riyad Karmy-Jones
- Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, United States
| | - Elizabeth Windell
- Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, United States
| | - Seth Izenberg
- Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, United States
| | | | - William Long
- Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, United States
| | - Matthew J Martin
- Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, United States; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, United States.
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